Understanding attitudes and obstacles to vaccination against COVID-19 in patients with primary immunodeficiency

Abstract

Background Patients with primary immunodeficiency (PID) are at increased risk for infections such as SARS-CoV-2 (COVID-19), due to the nature of their diseases and being immunocompromised. At this time, four vaccines against COVID-19 (Pfizer-BioNtech’s Comirnaty®, Moderna’s Spikevax®, AstraZeneca’s Vaxzevria®, Johnson & Johnson’s Janssen®) have been approved for use by Health Canada. Due to the novelty of these vaccines, clinical studies in patients with PID are ongoing. Despite limited evidence, Canada’s National Advisory Committee on Immunization (NACI) recommend that patients with PID without any contraindications should be vaccinated with any of the approved vaccines as the potential benefits of being immunized against the virus likely outweigh the risks of contracting a severe infection. The aim of this study was to understand the perceptions regarding COVID-19 vaccination among patients with PID and to identify specific factors related to vaccine hesitancy. Methods The Canadian Immunodeficiencies Patient Organization (CIPO) conducted an online survey of its members to evaluate uptake of the COVID-19 vaccines by patients with PID. Data was collected using a self-administered online questionnaire. The survey was conducted between March and April 2021. Results At the time of survey, among 370 respondents who had not received the COVID-19 vaccine, 302 respondents (81.6%) indicated they were very or somewhat likely to get vaccinated against COVID-19; and 68 respondents (18.4%) indicated they were somewhat or very unlikely, undecided, or not planning to get vaccinated. A large majority of respondents indicated they had a diagnosis of PID (67.8%) and/or specified their type of PID (27.7%). The most common reason for vaccine hesitancy was primarily due to uncertainty about immune response given an underlying immunodeficiency. Other concerns included unknown long-term side effects of COVID-19 vaccination, pre-existing history of allergic reactions, limited amount of data, lack of investigation of safety and effectiveness of COVID-19 vaccines in those with medical conditions, and skepticism of the underlying science and/or the medical system. Conclusions The results point to the importance of ongoing patient outreach, education, and up-to-date information on the rapidly evolving scientific knowledge and evidence on COVID-19 relevant to the PID community, from clinical trials to real-world evidence and observational studies.

Coronavirus disease 2019 vaccination uptake and hesitancy among Polish patients with inborn errors of immunity, autoinflammatory syndromes, and rheumatic diseases: A multicenter survey

“…Our data on vaccine hesitancy also agrees with the Canadian study results that reported the primary reason for vaccine hesitancy was uncertainty of the benefits ( 26 ). However, other studies reported safety concerns among patients with IEI or AIIRDs.…”

“…However, pharmacist-physician coaching (42) might be ineffective among patients with ultrarare and rare diseases since they generally seek professional advice from a specialist before receiving any vaccines. Our data on vaccine hesitancy also agrees with the Canadian study results that reported the primary reason for vaccine hesitancy was uncertainty of the benefits (26). However, other studies reported safety concerns among patients with IEI or AIIRDs.…”

“…Our results are similar to the Canadian study of IEI patients and a study that included patients with AIIRDs ( 15 , 26 ). In our study, patients with AIDs had the highest vaccination rate (94%), but we could not identify a previous study targeting this patient population.…”

“…In contrast to other studies on patients with IEI, half of the unvaccinated participants in this study declared the possibility of changing their choice (26). A study performed before introducing the vaccination program in the Netherlands presented a "watch and wait" strategy for patients unsure about vaccination.…”

“…In contrast to other chronic diseases and at-risk populations, vaccine hesitancy and willingness data is limited among those affected by IEI. For example, we only identified one Canadian study that used the SurveyMonkey Internet-based questionnaire platform conducted from April to May 2021 with a 40% response rate ( 26 ). Furthermore, the International Patient Organization for Primary Immunodeficiencies conducted a survey and presented the results during a November 2021 webinar organized by the European Society for Immunodeficiencies (ESID), but Polish patients were not represented ( 27 ).…”